For people with type 2 diabetes the failure of oral hypoglycaemic agents to control blood glucose levels may necessitate the prescription of insulin. Before insulin is given, lifestyle management including diet and exercise must be assessed and other possible factors such as recurrent infection and problems with medication ruled out.
- A single dose (10 units) of intermediate or long acting basal insulin once a day, before breakfast or at bedtime, in conjunction with oral hypoglycaemic agents may be adequate.
- If the dose is not adequate additional insulin should be given at slow and steady increments e.g. starting dose 10 units with changes of + 10–20% at intervals of 2–4 days.
- Quick acting insulin may not be required.
The basal insulin can be:
- Glargine – may cause less hypoglycaemia than Isophane
- Metformin – can be used later (and for the longer term) to help reduce insulin resistance, lower dose and decrease weight gain.
- Premixed insulin (human or analogue) can be used as an alternative to basal insulin.
- Either a single dose once a day before the largest meal, usually dinner, or 2 single doses before breakfast and dinner.
- The dose of premixed insulin should start low and rise in steady increments until the correct levels are achieved e.g. starting dose 10 units with changes of + 10–20% at intervals of 2–4 days.
Diet, Exercise and Insulin
- A regular eating and exercise schedule is advised to help predict blood glucose levels.
- Insulin will work regardless of eating or physical activity.
National Diabetes Services Scheme (NDSS)
The Australian government subsidises diabetes-related products through the National Diabetes Services Scheme. The NDSS is administered by Diabetes Australia with outlets across the country and online. Eligible persons must register to use the scheme by completing the appropriate form and having it signed by their doctor.
Find out more about the NDSS.
Find out about NDSS outlets in Victoria.
Diabetes Australia and the Royal Australian College of General Practitioners, Diabetes Management in General Practice, 16th Edition 2010/11, Diabetes Australia, 2010.